Caring With Our Hearts
(816) 533-0922
www.CaringWithOurHearts.Org
cwohusa@gmail.com
https://docs.google.com/document/d/1IswcwtqYOwibFYVgAyK_ofsTcbNSRfAb/edit#heading=h.vhyest4r7kd6
Assessment for Personal In-Home Health Services
The questions in this guide provide a framework to evaluate the effectiveness of a person’s formal supports (In-Home Supportive Services, case management, etc.), informal supports (family members, friends), and care needs. There is no magic formula that determines when more formal support services are needed or when out-of-home placement is necessary. Every individual and her/his circumstances differ. However, limited informal supports coupled with high care needs can be strong indicators for increased use of formal community-based services or for investigation of out-of-home placement. This guide can be used for yourself or your loved one.
A. Daily Care Abilities and Need
1. How would you evaluate the individual’s abilities in the following areas?
Check all that pertain:
| Needs NoAssistance | Needs SomeAssistance | Needs a Lot of Assistance | |
| Eating | |||
| Toileting | |||
| Bathing | |||
| Dressing | |||
| Grooming | |||
| Walking | |||
| Transferring |
* If an individual “Needs a Lot of Assistance” in 2 or more of the activities listed above in # 1, it is important to consider increasing formal support services or even to consider looking into out-of-home placement options. Professionals use these “activities of daily living” (ADLs) to determine appropriateness for a variety of services and for triggering insurance payments for care at home or in institutions.
2. How would you evaluate the individual’s abilities in the following areas?
Check all that pertain:
| Needs NoAssistance | Needs SomeAssistance | Needs a Lot of Assistance | |
| Preparing Meals | |||
| Shopping | |||
| Transportation | |||
| Housekeeping | |||
| Preparing Medication | |||
| Taking Medication | |||
| Bill Paying | |||
| Using Telephone |
*If an individual “Needs a Lot of Assistance” in 2 or more of the activities listed above in #2, it is important to consider increasing informal or formal support services. Professionals use these “instrumental activities of daily living” (IADLs) to determine appropriateness for a variety of services.
3. How would you answer the following questions about special care needs?
Is the individual incontinent in bladder?
| Yes | No |
Is the individual incontinent in bowel?
| Yes | No |
Does the individual wander off?
| Yes | No |
Does the individual stay awake during the night?
| Yes | No |
Does the individual show combative behaviors, (e.g., shouting, hitting)?
| Yes | No |
Does the individual require tube feeding?
| Yes | No |
Does the individual require skin care treatment for an advanced stage bed sore?
| Yes | No |
Does the individual require frequent assistance in transferring to prevent falls, e.g., going from the bed to the wheelchair?
| Yes | No |
*If you checked “yes” for any of the questions above in #3, you may need to increase formal support services. Start investigating out-of-home placement options.
B. Informal (Family) Support Services
The ability of someone to remain at home often depends on the availability, quantity and quality of one’s informal supports, (e.g., services like personal care, shopping, housekeeping, cooking, etc. provided by spouse, family and friends). It also depends on the health and willingness of the primary informal caregiver to continue to provide care.
C. Formal (Agency Provided) Community-Based Services
The use of appropriate formal services (e.g., respite care, In-Home Supportive Services, case management, etc.) can be crucial for maintaining community independence and providing needed backup and relief to the informal, family support system. Refer to the fact sheet entitled “Community-Based Services for Seniors” for a list of some of the formal support services you can access.
If the individual already receives community-based services, it is important to evaluate the effectiveness of the combined formal and informal services in meeting the individual’s needs. If the combination has limited effectiveness in meeting the individual’s needs, you may want to consider accessing different or additional community-based services. You may also want to speak with your informal caregiver to discuss how the help he/she provides can better complement the formal support services you receive.
List any services that you believe the individual needs but is not receiving from the formal or informal support systems:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________